On a recent Tuesday morning, a bustling health care clinic is filled with the sounds you’d expect to hear from children who need to see the doctor. Coughing, sneezing and sighs from an upset stomach fill the air.

But this isn’t a doctor’s office or emergency room. Instead it’s at Gaston Middle School in Fresno. While the enhanced services are a welcome addition for students, faculty and staff members who are trying to keep everyone well, there’s another purpose that it serves — helping kids stay in school or make a more rapid return.

The clinic, which is run by health provider company Clinica Sierra Vista, isn’t just a larger school nurse’s office. It’s a full-blown clinic, which features primary-care services, pediatric care and immunizations. The school district said during a board meeting last year that the free clinics would be paid for by health providers and federal subsidies.

Absences drain money from schools

While school attendance is key for education, there’s also a financial incentive for schools to get kids in the classroom. According to the Centralia School District in Buena Park, a missing student means $48.30 in lost funding per day. That adds up fast for districts that have hundreds or thousands of students who aren’t making it into school regularly.

The state of California’s 2016 truancy report found that nearly 210,000 K-5 students in California missed 10 percent of the 2015-16 school year. That accounts for 7 percent of the students in the state, according to the report. This resulted in an estimated $1.52 billion loss in funding for the state’s school districts.

Chronic absenteeism, which is defined as missing three or more weeks per school year, is a major problem in several California school districts. A study that used data from the U.S Office for Civil Rights found that half of the nation’s chronically absent students were located in 4 percent of the country’s school districts.

Many of them are in California, owing partly to the state’s size but also to several systemic issues that California schools face.

About 18 percent of Fresno Unified students are chronically absent, according to data from the 2013-14 school year.

The Office of Civil Rights investigation found that 14 districts had the highest absentee rates in California: Los Angeles Unified (12.7 percent chronic absenteeism rate), Antelope Valley Union High (28.1 percent), San Diego Unified (11.6 percent), Fresno Unified (18.4 percent), Long Beach Unified (12.7 percent), Kern Union High (23.3 percent), San Bernardino City Unified (15.1 percent), Elk Grove Unified (12.3 percent), Stockton Unified (19.1 percent), West Contra Costa Unified (21.6 percent), Sacramento City Unified (14.8 percent), Oakland Unified (16.6 percent), San Juan Unified (14.7 percent) and Moreno Valley Unified (17.3 percent).

Improving attendance rates

David Kopperud, the chair of the state’s School Attendance Review Board and an education programs consultant for the Department of Education, said that despite the numbers that show a chronic absenteeism rate of 12 percent statewide, there’s a considerable amount of innovation coming from schools to tackle the problem.

“I’m seeing some really creative things in California,” he said. “I’m seeing progress that’s been a long time coming.”

A major push behind fresh approaches is Assembly Bill 2815, which took effect in 2017. The law expands the duties of attendance supervisors to do more than just track attendance — they’re also tasked with more aggressively identifying absent students and finding intervention measures. In addition, under the new law, the Department of Education should not just tabulate attendance issues, but instead proactively find ways to improve students’ attendance.

Fresno Unified School District Attendance Coordinator Kristi Jackson said the district’s health clinics are a part of that effort, although the factors behind absenteeism and truancy are complex and vary widely across families. The district’s Gaston Middle School clinic is the first of what will be a family of up to ten additional clinics. Gaston’s clinic opened in 2015, and will serve as the model for future facilities.

California’s school funding formulas shifted in 2014 to give greater flexibility to local districts. Fresno Unified used that to build up its number of child welfare attendance officers — there are now 23 on staff. Their role can be anywhere from being positive and helpful with providing resources for struggling families to more stringent tasks like informing parents that school attendance is required.

School attendance in California is compulsory, although parents can excuse illnesses. Truancy is defined as when a student is absent without a valid excuse for three full days in a year, misses more than a 30-minute period for three different days, or a combination of both factors. Students who are expected to miss school for a long time can be provided an independent study contract, which involves working with the school and teachers on expected assignments.

At many schools, chronic absences are often due to health-related reasons, such as asthma or lack of access to primary care, Kopperud said. “It’s really important students get those resources and that we continue to collect more data so we know which groups of kids we start to lose,” he said.

While it may seem obvious that missing school is not ideal, the impacts of missing large numbers of school days can be long term. According to Kopperud, chronic absence is a key indicator of success in later school years.

Groups of kids that are missing way too much school starting in the early grades can then get off track and end up with higher dropout rates and higher incarceration rates, he said.